Key result
Impaired post-PCI FFR is linked to ~395% higher MACE risk versus satisfactory FFR.
Why the study?
Does impaired fractional flow reserve after PCI increase the risk of major adverse cardiac events compared to satisfactory FFR?
Meta-Analysis (n=1,337)
Does impaired fractional flow reserve after PCI increase the risk of major adverse cardiac events compared to satisfactory FFR?
Odds Ratio: 4.95 (95% CI 3.39–7.22)
Absolute Event Rate: 21.4% vs 5%
p-value: p=<0.001
A persistently low FFR following PCI is strongly associated with worse clinical outcomes, including increased MACE, death, MI, and repeat revascularization.
Post-PCI low FFR was associated with higher MACE risk; leaves open whether optimization improves outcomes in prospective trials.
BACKGROUND: FFR is routinely used to guide percutaneous coronary interventions (PCI). Visual assessment of the angiographic result after PCI has limited efficacy. Even when the angiographic result seems satisfactory FFR after a PCI might be useful for identifying patients with a suboptimal interventional result and higher risk for poor clinical outcome who might benefit from additional procedures. The aim of this meta-analysis was to investigate available data of studies that examined clinical outcomes of patients with impaired vs. satisfactory fractional flow reserve (FFR) after percutaneous coronary interventions (PCI). METHODS: This meta-analysis was carried out according to the Cochrane Handbook for Systematic Reviews. The Mantel-Haenszel method using the fixed-effect meta-analysis model was used for combining the results. Studies were identified by searching the literature through mid-January, 2016, using the following search terms: fractional flow reserve, coronary circulation, after, percutaneous coronary intervention, balloon angioplasty, stent implantation, and stenting. Primary endpoint was the rate of major adverse cardiac events (MACE). Secondary endpoints included rates of death, myocardial infarction (MI), repeated revascularisation. RESULTS: Eight relevant studies were found including a total of 1337 patients. Of those, 492 (36.8 %) had an impaired FFR after PCI, and 853 (63.2 %) had a satisfactory FFR after PCI. Odds ratios indicated that a low FFR following PCI was associated with an impaired outcome: major adverse cardiac events (MACE, OR: 4.95, 95 % confidence interval [CI]: 3.39-7.22, p <0.001); death (OR: 3.23, 95 % CI: 1.19-8.76, p = 0.022); myocardial infarction (OR: 13.83, 95 % CI: 4.75-40.24, p <0.0001) and repeated revascularisation (OR: 4.42, 95 % CI: 2.73-7.15, p <0.0001). CONCLUSIONS: Compared to a satisfactory FFR, a persistently low FFR following PCI is associated with a worse clinical outcome. Prospective studies are needed to identify underlying causes, determine an optimal threshold for post-PCI FFR, and clarify whether simple additional procedures can influence the post-PCI FFR and clinical outcome.
No takes yet. Share an insight, caveat, or question.
Wolfrum et al. (2016) conducted a meta-analysis in Coronary artery disease (n=1,337). Impaired (low) fractional flow reserve after PCI vs. Satisfactory (high) fractional flow reserve after PCI was evaluated on Major adverse cardiac events (MACE) (OR 4.95, 95% CI 3.39-7.22, p=<0.001). An impaired fractional flow reserve after percutaneous coronary intervention was associated with a significantly higher risk of major adverse cardiac events compared to a satisfactory FFR (OR 4.95).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: